Hi, my teenage step son has been diagnosed with drug induced psychosis in the last few weeks. He’s on antipsychotics, still has periods of mania and even though he hasn’t admitted it we believe it appears he’s hearing voices. What I want to know is when dealing with him when he’s getting agitated and aggressive and manipulative do we ignore the behaviour or do we correct the behaviour when he’s way above baseline? Its hard for his parents to stay calm when he’s absolutely disgusting and disrespectful towards them and believe me that is not the kid we all know and love and I don’t blame them, its hard to stay calm when you hear some of the things coming out of his mouth. But any ideas whats best? Do you let your frustrations out with him or do you ignore it and deal with it when he’s come out of his episode? Yes he is unwell and honestly there isn’t any point arguing with someone that isn’t listening or cares but no you can’t go around treating people like that. Its a tough one really.

Dealing with your son calmly is what I would recommend. Setting behavior limits works for some people, you really have to figure out what is best for your situation. There is no reasoning with my son when he is in a full blown episode.

We too experience a lot of the “disgusting and disrespectful” verbal aggression towards us when our son is agitated and escalating. The language and accusations are beyond anything we could’ve ever imagined coming out of our child’s mouth. We used to think we should just stand there and listen to it, so he would feel he’s been heard, or we would let our frustration out by talking back to him, but now we just remove ourselves from his presence as quickly as possible. There’s no point in subjecting ourselves to the onslaught.

We’ve learned that there is nothing you can do to “correct the behavior” when he’s in an escalated state. Once he’s calm again, you can attempt to calmly state your dissatisfaction with his verbal aggression and you can clarify your behavioral expectations until you’re blue in the face, but even then he’ll probably do it again. Once he’s back in an escalated state, the disgusting stuff will probably come out of his mouth again. For our son, it’s like he has a box in his head that’s filled with all the gross words and thoughts. If he experiences any kind interpersonal stress, the box gets opened and out comes the disgusting rant.

I strongly recommend you set up a way to lock yourselves away from him, or lock him away from you. You need to be able to separate yourselves from him, to preserve your own mental health. Plus, removing yourself from his verbal abuse will lessen the reinforcement he gets when he’s engaging in the behavior. Decreased reinforcement might lead to a decrease in the behavior, or at least a decrease in the duration of the behavioral events.

I’m sorry this is happening but glad you reached out. You really can’t do much when they are psychotic and having an episode except stay out of their way. If they are damaging your property, step in to stop them but be careful. Sometimes a stop will work for my son but it really is best to get away if you can. Remove all knives and anything sharp. I had to take some things off my counter yesterday because my son was banging them on the wooden table or counter. Try to speak barely above a whisper. I wish you the best.
Sz admin has some tips from professionals on how to handle someone with psychosis. You can check their posts or try searching.

Never “vent” frustration or anger towards a loved person with sz. Vent here. Find close friends or NAMI support group where I can vent as much as I need to.

Calm, stable environments are helpful to a person experiencing psychosis.

For myself, I set boundaries. “I am leaving this conversation because of [yelling, curse words, insults, whatever it was].” Then, when calm, “I love you and we can talk about anything, even when we disagree, as long as we are both polite and kind.” Then I just walked away; sometimes the behavior shifted immediately. Sometimes it took longer. I would never act like nothing was wrong, but I had a very hard time learning to be calm and set boundaries instead of engage angrily. Once I did, I felt much better.

My family member is currently in treatment and, thankfully for this time, we are back to good communication. I think setting those boundaries helped me, though don’t know whether it helped my family member.

Many good suggestions above. I would add that I try to avoid eye-contact when my son is agitated - it seems be interpreted as aggressive, and he escalates further. Actually, ANY kind of response on my part is interpreted by him as aggressive.

I try to remove myself from the vicinity when my son is agitated.

When I leave, my son sometimes continues to contact me with text messages. I can respond simply to those, saying something like ‘I’m sorry you feel that way. Hope you feel better soon.’

Thanks for all your responses. I am pretty good at remaining calm in these situations, my partner not so much. It is very difficult to deal with this frustration and yes as has been said in your comments, now that my partner responds aggressively his son has decided that his dad is in psychosis not him.

I found complete silence in the face of aggression and verbal abuse worked fastest to “bring him down”. No sarcasm, no defensiveness, no eye rolling. Let him listen to himself. If he insists on a response, just reflect: “I can see you are very upset. I’m sorry if I have hurt your feelings.” That kind of thing. But total attentive silence was very effective.

The one time we got to the point where he had his hands round my throat (but hadn’t yet squeezed!), I used CBT: “You can stop yourself. You know you can. You’ve done it before. You know you always regret it when you do something like this.” I just spoke very calmly and he took his hands away. I actually know a martial arts move to get out of that situation but I thought CBT would be better than putting him in hospital. I thought we’d never come back from that!

That sounds like how my son was before he started taking the Olanzapine. He is much better now, the aggression is gone and he does not talk to me like that. I was shocked when he started talking to me very disrespectfully as he never done that in the past. I ignored it as best i could and tried to remain calm, but when he started following me around the house and wouldnt leave me alone I called the crisis help line and the police. I got the JP to fill out a form 2 and the police came and picked him up and took him to the hospital. Where he remained for a month until he started on the meds and was back to his old self. I am not sure if he hears voices or what other things are going on in his head as he wont talk to anyone about it, but he refuses to leave the house or talk to anyone on the phone, including any of our family. I hope some day this improves and i try to coax him out although he refuses each time. I am just happy for now that he mostly seems back to his old self . So i guess my answer is that if he is still acting out and being disrespectful , i would think he should be on a different medication.